1., FULL ,?

: First N�ílle
Last Na�e

,.
NAME � :
,, '
...
...

OF CHILD ] r James ., 'Matthew Prieto

2. SEX 3a NUMBER OF CHILD�EN 1 � 4a. DATE (Month) (Day)

1-}b· Hour
� bom ot this pre¡;mancy � - OF " ,: , .

3b. lf �ore than ene, nu�Der - ', CH(LD'S

, • ' 1

-,
'

- T .-,J (h,c. rh,lrl ,., ...�-.;r ni b[rlh - . � '.RT: : Decamber 0 1 , 2ÓD7 ;

: , 05·46 PM

PLÍCE�/-L Sa. NEW YORK CITY = _J-Sb Naméof-Facility (it not in institution streel address) ·J Se. TYPE OF-PLACE

OF l BOAOLJGH OF Í

'
81 '
I �TH _ ! M_anhattan, ! Bellevue Hospi!cal center •'C r. rr ¡ , Hospital"

6a:. MDTR_E�'S l=ULL MAID6N NA�E 6b. MOTHER'S.OATE.Of:,-BIATH i 6c. MOTl-{E�:s BIRTHPLACE

... (Moñth) {Day)_� (Year) J City & state or !orelgn counlry

/ -

l
Gladis Alexandra Merchan ¡ 04/26/1984 :'
Ecuador

·' r-
7:-
-:c
_ M -::
O -:
T:-:
H -::
ER:::
-::
'S-:-
U c:
Sc-
U:-:
A -:-
L-:
R:-:
E:-:
S ;c
D
l :,
E:,
N ,:-
8
_ ,c
E
•:-:=-.
-:7
:,c
- "'
.c :::
:--
, ty�:--
.,o -w-n
7 �
-
.°'
"''"
'o-c
a"'
'"
toi-,,
-:,
-:-
_,._
.;..
_,.
-:
,7 :'
d,-
"'
:-s"-
1r
n".;
- ,
� a
n-d
""h
o"'
ú "'
s_e
_ n
_ "
_ m"b
- e
L r
--:;
-:c,
- -----:
,.-
--,
-'T
-
i7-e
- -
.n
,-,
� d
,.,
e-c
- ty
i ...:.
-,

a. State:b.Cou�y r -F:- I ]¡-67-30¿_�tJ1--Av�nue··'>�� - ¡ - -' l i m i t s o t 7 c ?

NY I Queens Flushin �- i, Apt 1fl ,:,· � -11377 i Yes

Ba FATHER'S FULL NAME F�THER'S_DATE Oí- Bl8TH I ac, FATHER'S BIATHPL.ACE

, (Month) (Day) � (Year) " :·, C1ty & State or,for01gn country

i : 1 ' ,:

j
Hernan G Prieto 1 'Ecuador.,

- � 7 -
This certificate is filed pursuant fo Section 17�167 of the Administrative Code of the City ot New York and Section 207.05 of the New

York (lity Health Code.

' .. f• -_. � -

- '
• I

J.
' lf��cs�·�-
} .

'

- '
-�;;;�:�¡��,��;:\; t.\1� ·�r1·;:74>_f;>
- 'O�.J '
; ,, ,

.. _
\X..j l J(:)l\.íU�\.L.! -� City Registrar
�--· l.. .'.!.,:. ············--········· . .
City Registrar
(J)gnature) '

, - 1- � " ,F -! ,. ,/ , ')

Original Reoort Fueo . Decernber 07- - � ,28071

f//1_,_ 4.
• o•· .• • •· .. '$ , •·••·· . . . . . L•
�r � r,_ - _f;_
!/T/ ;
·,
? ,
,.
j j
,,j

•.
./,

VITAL RECORDS
THE CITY OF NEW YORK
i